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Mesothelioma Chemotherapy with Cisplatin

Cisplatin, also known by its brand name Platinol, works by creating a platinum complex that binds to DNA and cross-links it. A DNA cross-link is the result of a reaction between either a natural agent or a chemical agent with two different positions along the DNA. Keep in mind that DNA is a double helix, meaning it has two strands that form a spiral shape. Since there are two strands, cross-linking can take place either intrastrand (on the same strand) or interstrand (on the opposite strand).

In the case of cisplatin, its primary cross-link is at the N7 position of neighboring guanine nucleotides, causing intrastrand cross-links that damage the cell’s DNA. This activates the repair mechanisms for DNA, which finds that the cells are not salvageable. The mechanism than triggers the death of those cells instead.

In addition, the damage also stops the growth of new cells because the crosslink inhibits the production of purine, which is necessary for the formation of both RNA and DNA. Without RNA and DNA, the cancer cells cannot reproduce themselves through cell division.

How is Mesothelioma Chemotherapy Drug Cisplatin Administered?

The combination of Alimta (pemetrexed) and Platinol is the most effective mesothelioma chemotherapy drug combination for the treatment of mesothelioma and has become the standard of care.

The drugs are administered in the following method:

Day 1 of the 21-day mesothelioma chemotherapy cycle, 500mg/m2 of Alimta administered intravenously. Thirty minutes later, 75 mg/m2 of cisplatin administered intravenously.

The dosage amount of mg/m2 means milligrams per square meter of body surface area (BSA). There are different formulas to measure BSA, but the one that is most often used is Mosteller’s, published in The New England Journal of Medicine in 1987. However, in actual practice, an adult’s BSA is considered to be 1.7 m2.

What Side Effects can Result From Taking Mesothelioma Chemotherapy Drug Cisplatin?

Medline Plus, a service of the U.S. National Library of Medicine, lists the following side effects and recommendations regarding whether or not your doctor should be called:

Cisplatin side effects are common and may include:

  • Thinned or brittle hair
  • Loss of appetite or weight
  • Diarrhea
  • Nausea and vomiting
  • Changes in taste
  • Numbness or tingling in the fingertips and toes

Tell your doctor if the following symptoms are severe or last for several hours:

  • Vomiting
  • Fatigue

If you experience any of the following symptoms, contact your doctor immediately:

  • Unusual bruising or bleeding
  • Black, tarry stools
  • Fever
  • Chills
  • Dizziness or feeling of faintness
  • Pain in your side or back
  • Shortness of breath or wheezing
  • Swelling of the feet or ankles
  • Seizures
  • Rash

Special Instructions for Use of Cisplatin for Mesothelioma Chemotherapy

Cisplatin causes cumulative kidney damage. That’s why kidney function and magnesium, sodium, potassium and calcium levels should be checked before starting cisplatin treatment and before each course of therapy. To maintain the correct level of urine output and to reduce toxicity, patients should receive intravenous hydration with 1-2 liters of fluid over 8-12 hours before treatment, followed by adequate hydration for the next 24 hours.

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